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Intracerebral Hemorrhage (ICH) Score

Calculators  Neurology
Intracerebral hemorrhage(ICH) score is quick and effecient grading scale which helps to predict the mortality rate in patients presented with ICH
3-4 2
5-12 1
13-15 0
Age ≥80
No 0
Yes 1
No 0
Yes 1
Intraventricular hemorrhage
No 0
Yes 1
Infratentorial origin of hemorrhage
No 0
Yes 1
Result:

Background

Measured Factor
ICH score
Measured Factor Disease
  • Intracerebral hemorrhage
Measured Factor Detail
ICH score gives the prediction value for the mortality in patients with ICH. This ICH score can be used clinically to develop better treatment protocols and in clincal studies
Speciality
Neurosurgeon
Body System
Neurology
Measured Factor Low Impact
  • 0
Measured Factor High Impact
  • 6

Result Interpretation

Ranges Ranges
  • Critical Low: 0%
  • Critical High: 600%
  • Normal: 0
  • Normal Adult Male: 0%
  • Normal Adult Female: 0%
  • Normal Pediatric: 0
  • Normal Neonate Female: 0
  • Normal Geriatric Male: 0%
  • Normal Geriatric Female: 0%
Result High Conditions
  • 100% mortality can occur
Test Limitations
Factors not represented in the ICH Score, such as location of ICH (eg, basal ganglia, cerebellum), time of onset, medical comorbidities and patient treatment preferences limits its application in small population.
References: 2

Studies

Study Validation 1
This present comparative study was conducted with the sole purpose to validate association between high neutrophil-tolymphocyte ratios (NLR) with poor short-term mortality in patients with intracranial hemorrhage (ICH). A total of 181 patients with ICH were recruited from 2016 to 2017. CT scan was the diagnostic criteria to confirm ICH in patients. Comparison of patient survival was done between subjects with high NLR (above the 7.35 cutoff; n = 74) versus low NLR (≤ 7.35; n = 107) using Kaplan-Meier analysis. The primary factor measured was 30 day mortality with secondary endpoints included C-reactive protein (CRP), fibrinogen, intraventricular hemorrhage, ICH volume. ICH and GCS score was calculated in all patients. This study concluded that higher 30-day mortality in ICH patients with high NLR (> 7.35). Multivariate regression showed that high NLR is an independent risk for 30-day mortality.
References: 3
Study Validation 2
This present comparative study was conducted with the sole purpose to validate association between high neutrophil-tolymphocyte ratios (NLR) with poor short-term mortality in patients with intracranial hemorrhage (ICH). A total of 181 patients with ICH were recruited from 2016 to 2017. CT scan was the diagnostic criteria to confirm ICH in patients. Comparison of patient survival was done between subjects with high NLR (above the 7.35 cutoff; n = 74) versus low NLR (≤ 7.35; n = 107) using Kaplan-Meier analysis. The primary factor measured was 30 day mortality with secondary endpoints included C-reactive protein (CRP), fibrinogen, intraventricular hemorrhage, ICH volume. ICH and GCS score was calculated in all patients. This study concluded that we found higher 30-day mortality in ICH patients with high NLR (> 7.35).
References: 4
Study Validation 3
This study aimed to validate ICH scale in patients with intracerebral hemorrhage (ICH) presenting to the University of California, San Francisco during 1997-1998. Logistic regression was used as a predictor of 30-day mortality. ICH score from 0-5 in 152 patients was calculated using GCS (Glasgow coma Scale), Age, and ICH Volume as evaluation parameters. Based on ICH score 30 day mortality was assessed. This study concluded that ICH score can be used clinically as it is simple to utilize.ICH Score could be used as part of risk stratification for ICH treatment studies, but not as a precise predictor of outcome
References: 1
Study Additional 1
This validation study was performed to derive and validate a single risk score for predicting death from ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Data of 33,865 stroke patients were analyzed and In-hospital mortality was calculated. Patients were divided into derivation and validation groups. Independent predictors of mortality (GCS (Glasgow coma Scale), Age, and ICH Volume) were analyzed statistically using logistic regression method and National Institutes of Health Stroke Scale (NIHSS) score for both subset and overall population was calculated. This study showed that calibration of the NIHSS score was excellent, as indicated by plots of observed versus predicted mortality in the study. So, this model can be used to predict risk of in-hospital death following stroke admission.
References: 5
Study Additional 2
This prospective study aimed to investigate the various prognostic factors for predicting function outcome and mortality in intracerebral hemorrhage (ICH) patients. A total 100 patient’s ≥12 year with primary non-traumatic intracranial hemorrhage were involved in the study. Clinical outcomes studied were Hypertension, comatose/stuporous, intraventricular hemorrhage, bilateral UMN signs. Further ICH scores was calculated using GCS (Glasgow coma Scale), Age, and ICH Volume. This study concludes that worsening of ICH can occur if . patient is presented with high ICH score, low GCS score at the time of admission, presence of intraventricular hemorrhage, and midline shift were significantly associated with poor clinical outcome.
References: 6
Study Additional 3
The aim of this study was to establish the long term survival and predictors of death in patients with intracerebral haemorrhage (ICH) in Finland between September 1985 and December 1991. A total of 411 patients with ICH were recruited in the study with 199 men and 212 women. Overall survival was seen in the patients using Kaplan-Meier analysis. Independent predictors of death within the first four weeks were unconsciousness, lateral shift of cerebral midline structures, mean arterial pressure > or =134 mm Hg, hyperglycemia, anticoagulant treatment, and ventricular extra-systoles. Predictors of late death for the 28 day survivors were old age, male sex, and heart failure. The study concluded the importance of primary and secondary prevention for ICH.
References: 7

References

  1. Hemphill JC, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001;32(4):891-7.
  2. Zahuranec DB, Brown DL, Lisabeth LD, Gonzales NR, Longwell PJ, Smith MA, et al. Early care limitations independently predict mortality after intracerebral hemorrhage. Neurology. 2007;68(20):1651-7.
  3. Wang F, Wang L, Jiang TT, Xia JJ, Xu F, Shen LJ, et al. Neutrophil-to-Lymphocyte Ratio Is an Independent Predictor of 30-Day Mortality of Intracerebral Hemorrhage Patients: a Validation Cohort Study. Neurotox Res. 2018;
  4. Banks JL, Marotta CA. Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke. 2007;38(3):1091-6.
  5. Smith EE, Shobha N, Dai D, Olson DM, Reeves MJ, Saver JL, et al. A risk score for in-hospital death in patients admitted with ischemic or hemorrhagic stroke. J Am Heart Assoc. 2013;2(1):e005207.
  6. Suthar NN, Patel KL, Saparia C, Parikh AP. Study of clinical and radiological profile and outcome in patients of intracranial hemorrhage. Ann Afr Med. 2016;15(2):69-77.
  7. Fogelholm R, Murros K, Rissanen A, Avikainen S. Long term survival after primary intracerebral haemorrhage: a retrospective population based study. J Neurol Neurosurg Psychiatry. 2005;76(11):1534-8.